Sometimes it is easier to describe depression by what it is not rather than what it is.
Depression is not “the blues.” It’s not simply feelings of melancholy, sadness or grief.
“It’s kind of like Charlie Brown’s friend Pigpen with that cloud that surrounds him all the time,” said Topher Hansen, president and CEO of CenterPointe in Lincoln, in reference to the Charles M. Schulz cartoon, "Peanuts."
“It (depression/mental illness) is the cloud through which everything must come and everything must go. It makes things that much harder -- impeding communication and creating that whole ambiance of the person seeing everything through that lens.”
News of beloved actor/comedian Robin Williams suicide Monday brings to the forefront the struggle of living with mental illness -- and a crisis brought on by the lack of understanding and awareness.
Mental illness affects one in four American adults each year, costing $193.2 billion in lost earnings annually, according to the National Alliance on Mental Illness.
Of those 61.5 million Americans, 25 million live with depression. And 9.2 million adults have both mental health and addiction disorders, NAMI said.
Nine of 10 suicides are committed by people suffering from a mental illness and in 60 to 70 percent of the cases where depression was the disorder, said Dave Miers, mental health services manager for Bryan Medical Center.
“Not all people with depression are suicidal, but a high percentage of those who are suicidal are depressed,” Miers said.
Depression also is linked with heart disease. Not only are people diagnosed with heart disease more likely to be depressed, but people with depression are more likely to develop heart disease and die from a heart attack than those who are not depressed, according to NAMI.
“Depression is complex,” Miers said.
Its causes are many -- biological, genetic, environmental and psychological.
“It is believed chemicals in the brain -- neurotransmitters are not communicating properly, resulting in a chemical imbalance,” Miers said.
Depression is as powerful a drive as the everyday drive to go eat food, Hansen said.
“There is nothing that happens that you are not looking through that cloud or that lens. It is very consuming. It is the state of being,” he said.
And so a person suffering from depression can no more “snap out of it” or “pull themselves up by their bootstraps” any more than a person with cancer can will themselves cured.
“Depression is an illness of the brain,” Miers said. And like any other illness, it needs treatment to overcome.
Often, people suffering depression may not recognize it. They don’t know why they feel the way they do. Or why they cannot concentrate. Why they inexplicably lash out in anger. Why they have no energy, no motivation. Why they feel so disconnected from everyone and everything.
They also are very good at hiding it -- working to appear normal on the outside, while inside they are disappearing.
It’s easy to be fooled or oblivious, said the Rev. Jim Keck, senior pastor at Lincoln’s First-Plymouth Congregational Church.
This spring, the congregation lost its longtime director of media, programming and operations and perpetual spark, Tammy Alvis, to suicide.
“We miss it,” Keck said. “We go too far on minimizing the size of the serious depression around us.”
It’s a lesson, Keck and the congregation learned in a very tragic way. Alvis made no secret of her personal struggles, but she excelled at presenting a positive, compassionate air in which everyone felt safe and accepted.
Ironically, that’s probably why those around Alvis missed the signs.
“I really have learned that if someone speaks of hurting themselves, never minimize it,” Keck said, even if the person making the statement tries to brush it off.
“It has to be actionable. If we care about people enough, we have to know it has been said and that it is not a secret we can keep. We have to tell a loved one or a doctor.
“We have to be more open about depression,” Keck said.
And open to talking about it. Open to stepping in and helping. Open to seeing it as a legitimate and treatable illness, rather than a personal failure. Open to eliminating the stigma.
“Depression is number one in what I watch for in human suffering,” Keck said. “It is epidemic.”
And it's insidious.
Family and friends are crucial in helping those suffering from depression.
“It is important for people to know the risk factors and signs to look for, and how to get people connected,” Miers said.
He and Hansen recommend that families have a crisis plan.
“It is sort of like a health-care directive,” Hansen said, comparing it to advance directives people make when they are aging or facing chronic, incurable diseases.
“Arrange it in a good moment … in anticipation of an event that will happen sooner or later,” Hansen said.
In that plan, establish an agreement that a loved one will set the wheels in motion when you tell them you are depressed.
“It is important that families know the treatment options out there,” Miers said. Talk to the family doctor. Connect with a therapist or psychologist in a non-crisis situation.
“Be understanding and be patient,” Miers said. “Become as educated as possible about depression. Be a good listener and be a good support system to them.”
Miers recommends people go online and take the anonymous/confidential depression screening (bryanhealth.com/onlinedepressionscreening).
“It is a good tool,” he said. “It opens that door, that maybe ‘I do need to do something.’
“Depression is very complex. It is also very treatable. … It is the most treatable of all mental illnesses.”
Therapies include medications, such as antidepressants and anti-anxiety drugs, and counseling/therapy -- a combination of both often yields the quickest results, Miers said.
Mental illness does not have to be disabling, Hansen said. Many people with chronic depression manage it and live rewarding lives -- even with all the ups and downs.
“So often depression and mental illness are portrayed as a Chutes and Ladders-style illness,” Hansen said. “That you climb slowly day by day up the ladder and then all of a sudden you hit whatever and the chute takes you all the way down to the bottom and you have to start all over.
“That portrayal is so wrong. You are not starting at the bottom, but starting where you are. That Chutes and Ladders thing beats the crap out of people. … We have the shift the paradigm to being where you are and progressing forward from the point at which you are -- not starting from the beginning again because you have failed.”
And when you slip, it is OK to ask for help.
“It is a sign of strength to ask for help,” Miers said. “Things can get better.”